INTRODUCTION TO ORAL CANCER

WHAT IS ORAL CANCER???? known medically as a malignant neoplasm, is a large group of different diseases , all involving unregulated cell growth & uncoordinated with that of the normal tissue.

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Such unregulated growth of cells(MALIGNANCY) which takes place in oral tissues is known as oral cancer

Usually squamous cell (epithethial) Abnormal neoplasm of the mouth

Found in most cases by a dentist or the person themselves.

 HOW CANCER CELLS ACT DIFFERENTLY FROM THEIR NORMAL COUNTERPART?

CLONALITY AUTONOMY ANAPLASIA METASTASIS

Statistics
56,000 people a year diagnosed 10,000 deaths Higher than:
Cervical cancer Hodgkins disease Brain cancer Liver cancer Testicular cancer Kidney cancer And malignant skin cancer

Who is at risk?
People over the age of 40
Men vs. Women Ethnicity Socioeconomic Status (SES)

Being a heavy smoker and drinker People with HPV-16 and HPV-18 are at slightly higher risk

Signs and symptoms

Sores or lesions that wont heal Lump or thickening in the cheek White or red patches on the gums, tonsils, or mouth Chronic sore throat Difficulty swallowing Difficulty moving mouth or tongue Numbness in any area of the mouth Swelling of the jaw

Oral cancer images

Treatments most commonly used

Radiation
Destruction of cells making it impossible for them to grow

Chemotherapy
Use of chemicals to destroy cancer cells

Surgery
Oldest form for treating cancer

EPIDEMIOLOGY
PREVALANCE & INCIDENCE Developed countries 3- 5 % of all cancers Developing countries upt 40% of all cancers 2.5 lakh new cases in INDIA

 Seen in older age group people (5th 6th decade of life. IN INDIA MAJOR ETIOLOGIC FACTOR IS BETEL TOBACCO CHEWING --- Cancer of BUCCAL MUCOSA is found to be more BUCCAL MUCOSA 65% LOWER ALVEOLUS- 30% GINGIVOBUCCAL COMPLEX- 5%

Etiological factors
Genetic predisposition Atmospheric pollution Immunosuppression Viruses Fungal infection Diet Dental sepsis

Tobacco Alcohol

Tobacco
Carcinogens of tobacco Benzopyrene tobacco specific nitrosamines Act locally on keratinocyte stem cells Affecting DNA replication Causing mutation

 Smoked tobacco
Bidi,Chillum,Chutta Cigarettes Dhumti Hookah Gudakhu hookli

Tobacco forms

 Smokeless tobacco
Khaini Mainpuri tobacco Mawa Mishri Paan Snuff Zarda

Alcohol
Pure ethanol is not carcinogenic Nitrosamines and other impurities Rising incidence of oral cancer linked to rising alcohol consumption

Alcohol
Ethanol increases mucous membrane permeability Ethanol metabolised to acetaldehyde locally by bacterial alcohol dehydrogenases and can damage cells poor oral hygiene Alcoholic liver disease reduces detoxification of carcinogens High calorie value suppresses nutrition and leads to nutritional deficiencies

Risk factors
Genetic predisposition ? - impaired capacity to metabolise carcinogens - DNA damage repair impaired Atmospheric pollution - polycyclic aromatic hydrocarbons/nitrosamines/benzenes

Risk factors
Immunosuppression - organ transplant patients lip cancer - no increased risk with AIDS of oral SCC Viruses -HPV 16 and 18 viral oncogene deactivates p53 inhibit apoptosis

Risk factors
Other viruses Herpes simplex Epstein-Barr virus Hepatitis virus no clear evidence of involvement in oral cancer

Cancer causes following psycological problems

Family problems low financial status due to increase expenditure on treatment No treatment Loss of interest of patient towards life Depression

PYSCOLOGICAL EFFECTS
Dysphagia resulting from head and neck cancer has psychosocial implications. The inability to participate in mealtimes and dining out as they are accustomed to can be isolating. Increased mealtimes, limited food choices, special food preparation methods, and untidy consumption contribute to avoidance of social food consumption

PYSCOLOGICAL EFFECTS
Use of tube feeding, diet modifications, adaptive equipment, or rehabilitative strategies for safe and adequate intake can call attention to themselves and thus become a source of anxiety.

Family relationships can be altered when substantial lifestyle modifications are encountered.

Socioeconomic effects of oral cancer

Financial burden was observed in 36% of cases and 43% of controls

This burden was mainly due to discontinuation or loss of job and expenditure on treatment, medicine, transport and accommodation away from home.
Disruption of routine activities was mainly because of the need of some one looking after the patient's activities

Early Detection Saves Lives

5-year survival for localized disease is 76% 5-year survival for metastatic disease is 19%

Early detection
If cancer can be detected early, treatment may be curative.
One means to that end is educating people regarding early signs of the disease: lumps, sores that do not heal promptly, abnormal bleeding, and persistent indigestion or hoarseness. Medical attention should be sought when these occur. Early diagnosis of cancers that are curable if detected early (cervix, breast, mouth) can be promoted in India using public education and training of primary health care workers.

Early Detection is Often Possible

A second approach to early cancer detection is through population screening; namely, the identification of people with asymptomatic disease by applying simple tests. Cancer screening should be applied only when its effectiveness has been demonstrated; programmes should be introduced only when there is adequate manpower to perform the tests

Warning Signs

Leukoplakia Erythroplakia

Other Possible Warning Signs

Lump or thickening of oral soft tissue Soreness or lump in throat Difficulty chewing or swallowing Ear pain Difficulty moving jaw or tongue Hoarseness Numbness of tongue or mouth Swelling of the jaw

Strategies for cancer control

A number of strategies can be considered for the control of cancer. An activity should only be introduced if data that strongly support its effectiveness are available, either from research programmes or cancer control programmes elsewhere.

Prevention
At least 30% of the future cancer burden is potentially preventable by tobacco control. Spread of tobacco addiction, promoted by commercial interests in the world, is responsible for the lung cancer epidemic that is already taking hundreds of thousands of lives annually; unless checked, cigarettes will in the next decade cause more than 1 crore deaths from cancer.

Prevention
Action is also possible on dietary modification. Evidence that excessive fat in the diet may induce some cancers and that whole grains, vegetables and fruits are protective has accumulated in recent years. The same diet that lowers the risk of cardiovascular disease may inhibit the development of diet-associated cancers.